Psychometric Evaluation of the Good Death Index from Patients with Terminal Cancer’s Perspectives - A Mixed-Methods Study

Sep 21, 2026

Patients with terminal illness often experience substantial physical and psychological suffering that also burdens family members through clinical decisions and ongoing care. Establishing how patients and families understand a “good death” is essential for refining palliative care planning and advance-care models. This mixed-methods study develops the LED Good Death Index by combining in-depth patient interviews with expert qualitative analysis, yielding an assessment tool for self-evaluating approach to a good death.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Background

Aim

Methods

Results

Conclusion

Introduction

Journal of Multidisciplinary Healthcare Dovepress Open Access Full Text Article ORIGINAL RESEARCH Psychometric Evaluation of the Good Death Index from Patients with Terminal Cancer’s Perspectives: A Mixed-Methods Study Shih-Hsuan Pi 1–3 , In-Fun Li4 , 5 , Pei-Yi Li 6 , Yuen-Liang Lai 7 , Chun-Kai Fang 6–9 1Department of Medical Research, Tamsui Branch, MacKay Memorial Hospital, New Taipei, Taiwan; 2General Education Center, MacKay Junior College of Medicine, Nursing, and Management, New, Taipei, Taiwan; 3Department of Crime Prevention, Central Police University, Taoyuan, 33304, Taiwan; 4Center of Long-Term Care, Tamsui Branch, MacKay Memorial Hospital, New Taipei, Taiwan; 5Department of Nursing, MacKay Medical College, New, Taipei, Taiwan; 6Department of Thanatology and Health Counseling, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; 7Hospice and Palliative Care Center, Tamsui Branch, MacKay Memorial Hospital, New Taipei, Taiwan; 8Department of Death Care Service, MacKay Junior College of Medicine, Nursing, and Management, New Taipei, Taiwan; 9Department of Psychiatry, MacKay Memorial Hospital, New Taipei, Taiwan Correspondence: Chun-Kai Fang, Hospice and Palliative Care Center, MacKay Memorial Hospital Tamsui Branch, New Taipei, Taiwan, Email [chunkai.fang0415@gmail.com](chunkai.fang0415@gmail.com) | Background: Patients with terminal illness often experience significant physical and mental suffering. This distress affects the patients themselves, as they endure the pain of their condition and their family members, who are affected by the patient’s situation and medical decisions. Furthermore, exploring the patients’ and their families’ concepts of a “good death” is crucial for reflecting on the value of life and for planning treatment or care models (such as advance care planning) . Therefore, understanding the issues is essential in improving palliative care and the overall quality of life.
Aim: This study aimed to develop a clinical assessment tool for the self-assessment of patients with terminal cancer to determine whether they are approaching a good death.
Methods: Our good death concept was developed through in-depth interviews with terminal cancer patients and qualitative analysis by experts in a research program. Three themes were analyzed: “living in dying (L)”, “experiencing the existential self (E)”, and“dying in living (D).” Therefore, the principal and co-principal investigators designed the primary LED Good Death Index (LED-GDI) based on three major themes and 15 subtopics of the LED Good Death concept.
Results: A total of 144 participants completed the LED-GDI assessment. Cronbach’s alpha for the LED-GDI was 0.854. We found that the LED-GDI allowed patients to assess whether they were approaching a good death.
Conclusion: The philosophical concept of LED-GDI is particularly in line with Confucian culture in East Asia and emphasizes the importance of living well before death. Therefore, the most critical goal of clinical end-of-life care is to determine whether patients with terminal illness can achieve a good death and live until the last moment.
Keywords: attitude to death, existentialism, good death index, end-of-life care | | --- | | Introduction
Achieving a good death for all is prioritized at societal and political levels. This needs to train and educate healthcare professionals to ensure rigorous assessment of end-of-life care services and explore best resource use.1 The good death is subjective and based on personal, cultural, social, political, and religious perspectives.2 Based on Confucianism and Buddhism, the concepts of good death among East Asian countries have unique viewpoints from Western culture.3–6 All clinical psychometric tools for good death were developed based on modern Western theories. Even if there are studies that perform cultural corrections, psychometric tools developed from Eastern cultures for the concept of a good de

FAQs

What is the purpose of the LED Good Death Index in this study?

It was developed to help patients with terminal cancer self-assess whether they are approaching a good death.

How was the concept underlying the index developed?

The good death concept was formed through in-depth interviews with terminal cancer patients and qualitative analysis by experts in a research program.

What psychometric evidence was reported for the LED-GDI?

In total, 144 participants completed the assessment, and the Cronbach’s alpha for the LED-GDI was 0.854.

Sep 21, 2026

Uploaded by Genevieve